Provider Demographics
NPI:1730105404
Name:MULLINS, TIMOTHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:STE. 207C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:336-883-9728
Practice Address - Street 1:218 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4877
Practice Address - Country:US
Practice Address - Phone:336-878-6511
Practice Address - Fax:336-878-6512
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32806208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340016586OtherRAILROAD MEDICARE
NC7961316Medicaid
NC61316OtherBCBS
NCC85671Medicare UPIN
NC7961316Medicaid
NC209063CMedicare PIN
NC209063BMedicare PIN